Perforación uterina completa por dispositivo intrauterino (DIU). Tratamiento laparoscópico: reporte de caso clínico / Complete uterine perforation caused by intrauterine device (IUD). Laparoscopic management: Clinical case report

Resumen ANTECEDENTES: Los dispositivos intrauterinos son anticonceptivos seguros y eficaces, aunque con un riesgo de perforación uterina si quienes los aplican no tienen el suficiente cuidado y experiencia. La incidencia de perforación es de 1 a 2 casos por cada mil inserciones. OBJETIVO: Exponer un caso de perforación uterina completa por dispositivo intrauterino. CASO CLÍNICO: Paciente de 27 años, con antecedentes de: dos cesáreas, inserción de dispositivo intrauterino liberador de levonorgestrel tres meses posteriores a la última cesárea. En la consulta externa refirió dolor pélvico, sangrados intermenstruales y dos intentos fallidos de extracción del dispositivo. En la histeroscopia se observó una probable falsa vía y no se encontró el dispositivo en la cavidad uterina. La TAC abdominopélvica lo ubicó en la salpinge izquierda; ante la sospecha de DIU traslocado se decidió el procedimiento laparoscópico en el que se documentó al útero con perforación en la cara anterior derecha, con tejido de granulación y cubierto por peritoneo parietal; el DIU en el fondo de saco, orientado hacia la izquierda, fijo, con adherencias laxas. Se extrajo y, por solicitud de la paciente, se practicó la salpigectomía bilateral. Reporte del estudio histopatológico: salpingitis crónica moderada, con fibrosis y quistes simples serosos paratubáricos CONCLUSIONES: Los dispositivos intrauterinos son anticonceptivos extraordinariamente simples, seguros y de larga duración. En general, hay una baja morbilidad asociada con su implantación, incluso cuando se produce una perforación uterina la mayoría de las pacientes experimenta síntomas leves: sangrado transvaginal y dolor abdominal inferior.

Abstract BACKGROUND: Intrauterine devices are safe and effective contraceptives, although with a risk of uterine perforation if the user is not sufficiently careful and experienced. The incidence of perforation is 1 to 2 cases per thousand insertions. OBJECTIVE: Presentation of a case of complete uterine perforation by intrauterine device. CLINICAL CASE: 27-year-old patient, with a history of two cesarean sections, insertion of levonorgestrel-releasing intrauterine device three months after the last one. At the outpatient clinic she reported pelvic pain, intermenstrual bleeding and two unsuccessful attempts to remove the device. Hysteroscopy showed a probable false pathway and the device was not found in the uterine cavity. The abdominopelvic CT scan located it in the left salpingeal cavity; given the suspicion of a translocated IUD, a laparoscopic procedure was decided, in which the uterus was documented with perforation on the right anterior aspect, with granulation tissue and covered by parietal peritoneum, the IUD in the cul-de-sac, oriented to the left, fixed, with lax adhesions. It was removed and, at the patient's request, bilateral salpigectomy was performed. Histopathological study report: moderate chronic salpingitis, with fibrosis and simple paratubal serous cysts. CONCLUSIONS: Intrauterine devices are remarkably simple, safe and long-lasting contraceptives. In general, there is low morbidity associated with their implantation, even when uterine perforation occurs most patients experience mild symptoms: transvaginal bleeding, lower abdominal pain.

Migración de un dispositivo intrauterino a vejiga con litiasis vesical secundaria y cistitis recurrente como forma clínica de presentación. Reporte de caso / Migration of an intrauterine device to the bladder with secondary bladder lithiasis and recurrent cystitis as a clinical presentation. Case report

RESUMEN Fundamento: El dispositivo intrauterino ha sido utilizado durante muchos años como método anticonceptivo; una complicación infrecuente posterior a su inserción es la migración fuera del útero. La localización vesical y la formación de vesicolitiasis, son complicaciones asociadas a la migración. Objetivo: Presentar un caso de migración de un dispositivo intrauterino a vejiga con litiasis sobreañadida como inusual etiología de una cistitis recurrente. Presentación del caso: Caso clínico de un dispositivo intrauterino en vejiga en una paciente de 43 años, cuyo diagnóstico se realizó incidentalmente en estudio de cistitis recurrente; se diagnosticó imagenológica y endoscópicamente en consulta de Urología; se decidió tratamiento quirúrgico mediante cistolitotomía a cielo abierto y se extrajo un cálculo de 4x5 cm de diámetro. La paciente evolucionó satisfactoriamente. Conclusiones: Considérese la posibilidad de migración del dispositivo intrauterino a la vejiga con litiasis sobreañadida como causa de cistitis recurrente, en pacientes femeninas que tengan antecedente de uso de este método anticonceptivo, lo que constituye un elemento importante en el diagnóstico y tratamiento de la infección urinaria baja.

ABSTRACT Background: The intrauterine device has been used for years as a contraceptive method; a non-frequent complication after its insertion is migration out of the uterus. The bladder location and the formation of vesicolithiasis are complications associated with migration. Objective: To present a migration case from an intrauterine device to the bladder with overadded lithiasis as an unusual etiology of recurrent cystitis. Case report: Clinical case of an intrauterine device in the bladder in a 43-year-old patient, whose diagnosis was made incidentally in a recurrent cystitis study, it was diagnosed by imaging and endoscopy in the Urology consultation; surgical treatment was decided by means of open cystolithotomy and a stone 4x5 cm in diameter was extracted. The patient evolved satisfactorily. Conclusions: To consider the possibility of migration of the intrauterine device to the bladder with overadded lithiasis as a cause of recurrent cystitis in female patients who have a preceding use of this contraceptive method, thus it constitutes an important element in the diagnosis and treatment of urinary lower infection.

Study of occult uterine perforation in brachytherapy of cervical cancer / 中华放射肿瘤学杂志

Objective:To evaluate the difference of dosimetry between three-dimensional and two-dimensional plans based on CT images of occult perforation in brachytherapy of cervical cancer, aiming to provide clinical reference.Methods:A total of 817 patients with cervical cancer received simple intrauterine (intrauterine tandem plus vaginal colpostats) three-dimensional brachytherapy in Chongqing University Cancer Hospital from January 2019 to December 2020 were retrospectively reviewed. Among them, 16 patients had occul uterine perforation. Based on Oncentra Brachy Therapy plan system, the single prescription dose was 6Gy. Three-dimensional (3D group) and two-dimensional (2D group) plans were designed on the perforated CT images The target volume, conformal index (CI), conformal index coformity index (COIN) and organs-at-risk (OAR) D 2cm 3 parameters were used to assess the plans between two groups. Results:The incidence of pccult uterine perforation was 1.96%(16/817) during brachytherapy for cervical cancer. The volume of prescription dose curve in the 3D group was (40.74±14.98) cm 3, significantly smaller compared with (91.46±19.71) cm 3 in the 2D group ( P<0.05), whereas the volume of the high-risk clinical target area wrapped by prescription dose curve did not significantly differ between two groups ( P>0.05). The CI and COIN in the 3D group were 0.79±0.10 and 0.72±0.96, significantly higher compared with 0.38±0.09 and 0.37±0.18 in the 2D group (both P<0.05). The D 2cm 3 of bladder, rectum, sigmoid colon, small intestine in the 3D group were (306.06±77.57) cGy, (252.27±72.60) cGy, (127.25±62.84) cGy and (228.79±94.90) cGy, significantly lower than (548.03±164.21) cGy, (411.16±118.74) cGy, (227.45±94.48) cGy and (450.95±157.96) cGy in the 2D group (all P<0.05). Conclusions:Application of image guidance in brachytherapy of cervical cancer is helpful to detect occult uterine perforation. When occult uterine perforation occurs, the use of three-dimensional plan can basically meet the clinical needs, which is significantly better than the two-dimensional plan.

Migración de dispositivo intrauterino a vejiga / Intrauterine device migration to bladder

Introducción: La litiasis vesical secundaria se forma en el reservorio vesical y requiere la existencia de condiciones patológicas previas como lo son los cuerpos extraños. Objetivo: Describir dos casos clínicos de litiasis vesical secundaria a migración de un dispositivo intrauterino. Caso clínico: Se presentan dos casos de migración intravesical de dispositivo intrauterino con litiasis vesical secundaria. Se diagnosticaron años después de su inserción, ante la aparición de dolor pélvico, cistitis a repetición y hematuria. La laparoscopia no fue útil para su diagnóstico. En consulta de Urología la ultrasonografía y la radiografía de pelvis fueron herramientas diagnósticas útiles ante la sospecha inicial de esta patología. Presentaron buena evolución y regresión total de los síntomas tras cistolitotomía suprapúbica. Conclusión: Se debe pensar en la posibilidad de migración de un dispositivo intrauterino a vejiga ante la cronicidad de síntomas urinarios irritativos bajos en toda mujer que emplee este método anticonceptivo y desconozca su paradero(AU)

Introduction: Secondary bladder lithiasis is formed in the bladder reservoir and requires the existence of previous pathological conditions such as foreign bodies. Objective: To describe two clinical cases of bladder lithiasis secondary to intrauterine device migration. Clinical case report: Two cases of intravesical migration of an intrauterine device with secondary bladder stones are reported. They were diagnosed years after insertion, due to the appearance of pelvic pain, recurrent cystitis and hematuria. Laparoscopy was not helpful for its diagnosis. In Urology consultation, ultrasound and pelvic radiography were useful diagnostic tools in the event of the initial suspicion of this pathology. They showed good evolution and total regression of symptoms after suprapubic cystolithotomy. Conclusion: The possibility of an intrauterine device migration to the bladder should be considered when chronicity of irritative low urinary symptoms in every woman who uses this contraceptive method and which locations are unknown(AU)

Retained plastic instrument after 5 years of illegal abortion: a case report and literature review

The retained of a foreign body during a surgical procedure is defined by the forgetting of a material, left by inattention in the body of the patient during this act. It is a rare event but is responsible for high morbidity and mortality. Authors report a retained foreign body incidentally discovered during a caesarean section. The patient had performed an illegal abortion by endo-uterine instrument which was complicated by uterine perforation five years previously. She was pregnant at 37 weeks and presented to the emergency department for bleeding and diagnosed as placenta previa. The antecedent of abortion had not been informed because it is an illegal act in Madagascar. The plastic instrument was in the broad ligament in contact with the ureter and the uterine artery. Caesarean section, the removal of the catheter and postoperative recovery was uneventful. Foreign body retention remains a malpractice and the diagnosis must be made in the face of chronic pain in patients who have undergone surgery.

Procedimiento endoscópico en la migración al recto de un dispositivo intrauterino. Reporte de un caso / Endoscopic management in the migration to rectum of an intrauterine device. Case report

Resumen ANTECEDENTES La perforación es la complicación más temida durante la aplicación de un dispositivo intrauterino; cuando esto sucede debe retirarse el dispositivo debido al potencial riesgo de perforación y obstrucción intestinal. CASO CLÍNICO Paciente de 26 años, con trastorno del ciclo menstrual y dispareunia. La radiografía abdominal mostró el dispositivo intrauterino en posición anómala. La tomografía simple de abdomen evidenció el dispositivo en la zona intraluminal del recto, en la pared anterior, a 10 cm del esfínter anal. Se extrajo el dispositivo mediante colonoscopia. Los hallazgos intraoperatorios fueron: migración del dispositivo intrauterino, a 12 cm del margen anal, con adecuada exposición del brazo vertical. La extracción del dispositivo fue exitosa, con evolución satisfactoria de la paciente pues no hubo dolor ni alteraciones intestinales. CONCLUSIÓN La colonoscopia es una técnica diagnóstica y terapéutica efectiva en pacientes con migración del dispositivo intrauterino y afectación intestinal sin perforación, incluso puede considerarse antes de recurrir a la laparoscopia o laparotomía.

Abstract BACKGROUND Perforation is the most important complication during the application of an intrauterine device, which should be removed because of the potential risk of perforation and intestinal obstruction. CASE REPORT Female patient of 26 years of age, who presents menstrual rhythm disorders as well as dyspareunia. The tomography revealed the intrauterine device in the rectum, in the anterior wall, intraluminal, and 10 cm from the anal sphincter. It was scheduled for colonoscopy and device removal. The intraoperative findings were: migration of the intrauterine device, 12 cm from the anal margin, with adequate exposure of the vertical arm. The extraction of the device was successful. The patient had a satisfactory evolution, showed no pain or intestinal alterations. CONCLUSION Colonoscopy is a study of great help in all patients in whom migration of IUD with bowel disease without perforation and related complications is suspected, since it provides diagnostic and even therapeutic support, prior to considering a laparoscopy or laparotomy.

Perforation of pyometra presenting as obstructive acute abdomen and peritonitis: a case report / Perfuração de piometra apresentando-se como abdômen agudo obstrutivo e peritonite: relato de caso

ABSTRACT We report a rare case of a 67-year-old postmenopausal woman presenting diffuse peritonitis secondary to spontaneous perforation of pyometra with obstructive acute abdomen. During laparotomy was performed subtotal abdominal hysterectomy with bilateral salpingo-oophorectomy. The histopathology found the presence of moderately differentiated uterine squamous cell carcinoma. Despite intensive care, the patient died due to multiple organ failure resulting from sepsis on postoperative day 1. This case shows the importance of clinical suspicion on the acute gynecological diseases presenting as a systemic disease in the emergency room.

RESUMO Relatamos um caso raro de uma mulher pós-menopausa com 67 anos de idade, a qual apresentou como peritonite difusa secundária a perfuração espontânea de piometra com abdômen agudo obstrutivo. Durante a laparotomia foi realizada histerectomia abdominal subtotal com salpingo-ooforectomia bilateral. A histopatologia determinou a existência de carcinoma de células escamosas moderadamente diferenciado do útero. Apesar dos cuidados intensivos, a paciente veio a óbito por falência múltipla de órgãos decorrente de sepse no primeiro dia do pós-operatório. Este caso mostra a importância da suspeita clínica sobre as doenças ginecológicas agudas que se apresentam como doenças sistêmicas na sala de emergência.

Spontaneous Perforation of Pyometra

Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.

Dislodged Levornogestrel-Intrauterine System Intra-Abdominally without Uterine Perforation: Is it Possible?

We report a case of dislodged Levornogestrel-intrauterine system (LNG-IUS, Mirena®) without evidence of uterine perforation. A 37-year-old Para 4+1presented with 3 months history of lower abdominal pain. Examination and imaging showed that the device was not present in the uterine cavity. She underwent laparoscopic retrieval of Mirena®. There was no evidence of uterine perforation intra-operatively. This case illustrated the rare possibility of dislodged Mirena®intra-abdominally without evidence of uterine perforation. The management for missing IUS was reviewed.

Dispositivo intrauterino migrado a la cavidad abdominal con embarazo intrauterino no evolutivo: reporte de caso / Intrauterine device migrated to the abdominal cavity with non-progressive intrauterine pregnancy: case report

La migración de un dispositivo intrauterino a la cavidad abdominal es una complicación poco frecuente de este eficaz método contraceptivo, sin embargo debe sospecharse ante la imposibilidad de visualizar los hilos del dispositivo vía vaginal y la ausencia intrauterina del mismo por ecografía. Si bien la migración abdominal puede ser asintomática, algunos casos pueden producir clínica de severidad variable incluyendo dolor abdominal y complicaciones derivadas de la formación de adherencias o la perforación de vísceras pélvicas y abdominales. Su detección intraabdominal debe sospecharse en primer lugar por ecografía y confirmarse mediante radiología simple de abdomen. Una vez localizado el dispositivo migrado, se recomienda su extracción inmediata, incluso en casos asintomáticos, con el fin de evitar las complicaciones derivadas de su desplazamiento. La laparoscopia será de primera elección en estos casos para la extracción. Presentamos un caso de migración intraabdominal de dispositivo intrauterino concurrente a un embarazo intrauterino no evolutivo.

Migration of an intrauterine device to the abdominal cavity is a rare complication of this effective contraceptive method, however, it must be suspected upon the inability to visualize the wires vaginally and the absence of intrauterine device by ultrasound. While its abdominal migration can be asymptomatic, some cases may produce variable clinical severity including abdominal pain and complications resulting from the formation of adhesions or perforation of pelvic and abdominal viscera. Its intraabdominal detection should be suspected first by ultrasound and confirmed by plain abdominal X-ray. Once the migrated device is located, immediate removal is recommended, even in asymptomatic cases, in order to avoid complications arising from its displacement. Laparoscopy will be the first choice in these cases for extraction. We report a case of intraabdominal migration of intrauterine device concurrent with a non-evolutive intrauterine pregnancy.

Misdiagnosis reason analysis of uterine empyema complicated with perforation of the uterus in women aftet menopause / 中国综合临床

Objective To investigate the clinical features of uterine empyema complicated with perforation of the uterus,the causes of misdiagnosis and measures of reducing misdiagnosis.Methods Twenty clinical cases from 2008 to 2013 in the First People's Hospiptal of Shangqiu were treated postmenopausal,uterine empyema and uterine perforation,and 16 cases of whose first diagnosed leak or misdiagnosed patients were retrospectively analyzed.Summarize the clinical characteristics,misdiagnosis and experiences in order to reduce the misdiagnosis of the disease.Results Among 20 cases of uterine perforation and Uterine empyema,16 cases first diagnosed misdiagnosed,and the incidence was 80％ (16/20).One case was diagnosed tumor torsion,1 case of diagnosis of pelvic abscess,14 cases first diagnosed of surgery (8 cases of acute peritonitis,gastrointestinal perforation in 4 cases and 2 cases of perforated appendicitis).It all occurred in postmenopausal women,and the main clinical features were that:high fever,lower abdominal pain,feel bloated in the rectal,mass pelvic cavity,weakened movement of intestine and cervical disturbance pain.results of emoyemic bacteria culture were mainly colon bacillus (E.coli).The main causes of misdiagnosis were atypical clinical manifestations,clinicians lack of comprehensive analysis and dynamic observation of the disease,over-reliance on laboratory examinations;their performance was often the first diagnosis of acute abdomen surgery,the surgeon only undergraduate examination,as well as undergraduate diagnosis of inertia thinking,neglect gynecological examination.All patients had a one-time cure after surgery.Conclusion Uterine empyema complicated with uterine perforation occurs mainly in postmenopausal women,which had a higher rate of misdiagnosis.Correctly diagnosis and timely treatments make benefits to the prognosis.

Wandering intrauterine contraceptive device: An unusual travel to the sigmoid colon

Intrauterine contraceptive device (IUCD) is common choice for contraception. Migration of IUCD is one of the complications that are encountered. Here we report a case of IUCD migration to the sigmoid colon. A 39-year-old Malay lady carrying a copper T type of IUCD presented with missing thread then underwent examination under anaesthesia, proceeded to hysteroscopy but failed removal. Abdominal ultrasound detected it in the left lower quadrant of abdomen. She then underwent diagnostic laparoscopy where the device was found to be embedded in the sigmoid colon. Technical difficulty necessitated conversion to mini laparotomy and sigmoidotomy to remove the IUCD and the bowel closed primarily. IUCD is a relatively simple and safe contraceptive procedure but possible complications are bleeding and pain that usually co-exist, pelvic infection, expulsion and perforation. Investigations should be based on clinical suspicion and migrated IUCD in symptomatic patients should be surgically removed whereas, asymptomatic patients can be managed conservatively under certain circumstances. However in the presence of a concurrent pathology that requires exploration then retrieval of the migrated IUCD should be undertaken.

Intestinal Perforation as a Complication of Induced Abortion - a Case Report and Review of Literature.

Intestinal perforation is a rare complication of induced abortion but it is not rare in our country. It is most commonly seen in countries in which abortions are performed by people without proper training and with sharp pointed instruments without knowledge of anatomy. Bowel perforation occurs when the posterior vaginal wall or uterus is violated, allowing the instrument to pierce underlying structures. The ileum and sigmoid colon are the most commonly injured portions of bowel due to their anatomic location. Here we discussed a woman who sustained a perforation at anterior rectal wall from abortion and was managed successfully.

Uterine Perforation with Bowel Infarction in a case of Unsafe Abortion.

We report a case of a 30 year old female who presented with features of septic abortion with peritonitis 2 days after unsafe abortion of a 20 week pregnancy with uterine perforation with intrabdominal fetus with mesenteric and bowel injury that required bowel resection.

A case of generalized peritonitis secondary to a perforated pyometra in a patient with cervical cancer / 대한산부인과학회지

Spontaneous perforation of the uterus and subsequent generalized peritonitis is an extremely rare complication of pyometra. Although generalized peritonitis secondary to perforated pyometra is rare in patients with an acute abdomen, this condition should be considered in the differential diagnosis. We report a case of a spontaneous uterine perforation of a pyometra in a patient with cervical cancer with brief review of the literature.

A case of cystolithiasis after intravesical migration of Copper T intrauterine device / 대한산부인과학회지

An intrauterine device (IUD) is one of the most commonly used contraceptive method in the world. One of the major complications of intrauterine contraception is the perforation through the uterine wall into the pelvic or abdominal cavity. The incidence is 0.9 people per 1000. However, bladder perforation is even more rare. It happens mostly at the time when it was inserted. The symptom varies from no symptom at all to low abdominal pain, massive bleeding, et cetera. We report a case with displaced intrauterine device in bladder, producing the bladder stone which was managed with cystoscopic lithotripsy and intrauterine device removal, followed by a review of the literature.

A case of spontaneous uterine perforation result from acute gangrenous myometritis in an old woman with IUD for 40 yrs / 대한산부인과학회지

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidences of direct association between IUD use and pelvic inflammatory disease are rare, the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgeries on the account of purulent, inflammatory disease associated with IUD are 4-7%. We report one case with spontaneous perforation of uterus due to acute gangrenous myometritis in an old woman with IUD for 40 yrs in pelvic cavity, followed by a review of the literature.

Incidence of Complications of Hysteroscopic surgery & It's safety / 대한산부인과학회잡지

OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.

Incidence of Complications of Hysteroscopic surgery & It's safety / 대한산부인과학회잡지

OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.

A Case of Metastatic Choriocarcinoma with Uterine Perforation following Term Pregnancy / 대한부인종양콜포스코피학회잡지

Gestational trophoblastic tumor is one of the curable disease, but metastatic trophoblastic tumor still shows high mortality rate because of resistance to the chemotherapy. Choriocarcinoma may occur after an any type of human pregnancy. The incidence of choriocarcinoma following term pregnancy is very uncommon, and such tumor appears to follow a more aggressive course with more extensive metastatic spread and is less responsive to chemotherapy resulting in a poorer prognosis. Choriocarcinoma presenting as postpartum hemorrhage, and spontaneous tumor perforation with intra-abdominal hemorrhage is even rarer, requiring emergency laparotomy. We had experienced one case of metastatic choriocarcinoma following term pregnancy that required emergency total abdominal hysterectomy due to uterine perforation and hemorrhage. So, we report this case with brief review of literatures.